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JAMA Netw Open
. 2021 Jan 4;4(1):e2036142.
doi: 10.1001/jamanetworkopen.2020.36142.
Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge
Mattia Bellan 1 2 , Daniele Soddu 1 2 , Piero Emilio Balbo 2 , Alessio Baricich 1 2 , Patrizia Zeppegno 1 2 , Gian Carlo Avanzi 1 2 , Giulia Baldon 1 2 , Giuseppe Bartolomei 1 2 , Marco Battaglia 1 2 , Sofia Battistini 1 2 , Valeria Binda 2 , Margherita Borg 1 2 , Vincenzo Cantaluppi 1 2 , Luigi Mario Castello 1 2 , Elisa Clivati 2 , Carlo Cisari 1 2 , Martina Costanzo 1 2 , Alessandro Croce 1 2 , Daria Cuneo 1 2 , Carla De Benedittis 1 2 , Simona De Vecchi 1 2 , Alessandro Feggi 2 , Martina Gai 1 2 , Eleonora Gambaro 1 2 , Eleonora Gattoni 2 , Carla Gramaglia 1 2 , Leonardo Grisafi 1 2 , Chiara Guerriero 1 2 , Eyal Hayden 1 2 , Amalia Jona 2 , Marco Invernizzi 1 2 , Luca Lorenzini 2 , Lucia Loreti 1 2 , Maria Martelli 1 2 , Paolo Marzullo 1 2 , Erica Matino 1 2 , Antonio Panero 1 2 , Elena Parachini 2 , Filippo Patrucco 1 2 , Giuseppe Patti 1 2 , Alice Pirovano 1 2 , Pierluigi Prosperini 2 , Riccardo Quaglino 1 , Cristina Rigamonti 1 2 , Pier Paolo Sainaghi 1 2 , Camilla Vecchi 1 2 , Erika Zecca 1 2 , Mario Pirisi 1 2
Affiliations
- PMID: 33502487
- DOI: 10.1001/jamanetworkopen.2020.36142
Abstract
Importance: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown.
Objective: To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge.
Design, setting, and participants: This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results.
Exposure: Severe COVID-19 requiring hospitalization.
Main outcomes and measures: The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae.
Results: Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%).
Conclusions and relevance: These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.